Ministry of Health of Brazil, National Program to Eliminate Lymphatic Filariasis Lymphatic Filariasis Elimination in the Americas 6th Regional Program Managers

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Ministry of Health of Brazil,National Program to
Eliminate Lymphatic FilariasisLymphatic
Filariasis Elimination in the Americas6th
Regional Program Managers Meeting(San José,
Costa Rica, October 2005)
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Elimination Project / Context

• Decentralization of disease control, with
  autonomy of states and municipalities.
• Difficulties derived from poor conditions in foci
  (social debt) versus scarcity of .
• Need for better coordination of actions between
  agencies (federal, state, municipal levels).
• Partial assimilation of critical technical
  recommendations (such as MDA).

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Financial Support of PELF BrazilSpecial
Difficulties 2003

• TF-ECD (Teto Financeiro de Epidemiologia e
  Controle de Doenças).
• Monthly delivery of funds from FNS-National
  Health Fund/MoH to Municipal Health Funds
• For surveillance and control of all Endemic
  Diseases
• Predominance of Dengue control in local budgets
• Necessary guarantee funds for Filariasis in local
  budgets
• Complementary SVS funds

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Brazil LF Program Recent Progress

• Belem Evaluated via hemoscopic, ICT,
  entomo/PCR surveys
• Maceió ICTcard survey
• Recife MDA scaling up Morbidity survey
• Jaboatão, Olinda, Paulista Preparing for MDA
• Bahia under evaluation

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Brazil LF Program Challenges

• Accelerate elimination
• Sustained control of vector breeding sites Basic
  sanitation
• Complete control of human sources of infection
  by MDA
• Introduce new strategies
• Effective coverage
• Sustainability

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Brazil LF Program Roads/Perspectives

• Maintain traditional strategy
• Dynamize conventional methodology
• Adoption of innovative (MDA, DEC-salt) strategy
• Mixed treatment strategy
• MDA in main foci
• Selective treatment
• Truely Integrated Program
• Where can each road take us?

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Next steps Three Objectives for 2005
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Objective 1 MDA Expansion
Objective 2 Confirmation of elimination of
transmission
Objective 3 Development of
morbidity assistance
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Objective 2 Confirmation of elimination of
transmission The
Filariasis Elimination in Brazil Urban
Challenges, Focal Elimination and Its
Verification.


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• Why certify elimination?
• Confirm if patterns (index) verified and tools
  used are in accordance with WHO recommendation,
  as results will be a guide/pattern for next
  evaluations.
• Interrupt activities with social risk.
• Save/rationalize resources.
  

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• Regarding verification of elimination, focus has
  been placed on two situations
• Areas in process of verification
• Belém
• Maceió
• Areas of ancient foci
• Bahia (Salvador, Castro Alves)
• Maranhão (São Luiz)
• Manaus
• others
  

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• Concerning evaluation of foci
• Foci in process of verification
• The example of Belém
• Ancient foci
• Historical data
• Publications
• National databases (indirect data)
  

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• Other aspects to take into consideration
• Migrations inside country
• Large distances
• Persistence of unfavorable sanitary and
  environmental conditions
  

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• 2005 Evaluating Foci of Salvador
• Global view
• Conscripts survey
• 2. Focusing on historical areas
• Entomological survey
• ICT card survey in sample of students
• Hemoscopic survey in students of night
  schools(in relation to the results of
  entomological survey/s)
• 3. Morbidity
• Review cases identified by databases (SINAN,
  SIH-SUS)
• Prospective follow-up

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• Rescue of ancient data
• Data collected from IBGE and performing the
  synthetic risk index (ISR)
• Technicians trained to perform digital puncture,
  entomological collection, exams, and evaluation
  of morbidity cases.
• Materials acquired for both surveys.
• Partnership with Defense Ministry.
• Taking blood samples using digital puncture among
  young men at the time they present themselves for
  military service.
• Priority localities for mosquito collection
  established by identifying areas of intersection
  of ancient foci with those with the worst ISR.

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• Preliminary results
• Examined 6,000 conscripts.
• Some positive for W. bancrofti.
• Mosquitoes currently being collected.

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The work will continue .